BC Pelvic Pain

Question 1

What are three causes of pregnancy related pelvic pain?

Answer 1

ectopic, molar, abruption

Question 2

What are three structural areas that are associated with gyne pelvic pain

Answer 2

Ovary, tube, uterus

Question 3

What are causes of ovarian originating pelvic pain?

Answer 3

ruptured cyst, torsion

Question 4

What are causes of tubal originating pelvic pain?

Answer 4

PID, endometriosis

Question 5

What are causes of uterus originating pelvic pain?

Answer 5

leiomyoma, endometriosis

Question 6

What are non gyne causes of pelvic pain

Answer 6

Dysmenorrhea, ovulation pain, dyspareunia

Question 7

What are systemic issues that can cause pelvic pain?

Answer 7

Uro (interstitial cystitis, renal colic), MSK (fibromyalgia, GI (IBS/IBD< diverticulitis, hernias)

Question 8

What are non medical reasons for pelvic pain

Answer 8

mental health, depression, somatiziation, sexual, physical, psychological abuse

Question 9

What is the minimum diagnostic criteria for PID

Answer 9

Lower abdo tenderness, adnexal tenderness, Cervical motion tenderness

Question 10

How does PID present

Answer 10

Lower abdo tenderness worsening over days, cervical discharge

Question 11

What is the gold standard for PID dx?

Answer 11

Laparoscopy demonstrating abN consistent (fallopian tube erythema, discharge)

Question 12

What is a complication of PID?

Answer 12

Fitz Hugh Curtis Syndrome (inflammation of the liver capsule)

Question 13

What is the best way to dx herpes simplex?

Answer 13

viral culture (if lesions are present)

Question 14

Vaginal swabs for saline wet prep are testing for what?

Answer 14

trichomonas?

Question 15

When do you admit a PID case?

Answer 15

surgical emergency cannot be excluded (appendicitis), pregnancy, no response to oral abx therapy, unable to follow or tolerate outpt oral regimen, severely ill, tubo ovarian abscess, youth/adolescent (if compliance is an issue), HIV +ve

Question 16

What are the sexually transmitted causes of PID

Answer 16

Chlamydia trachomatis, neisseria, gonorrhea, viruses and protozoa (rare) (HSV, Trichomonas vaginalis)

Question 17

does BV cause PID?

Answer 17

Yes (Gardnerella vaginalis)

Question 18

how do u tx PID as an inpatient

Answer 18

Foxy Doxy (cefoxitin, doxycylin)

Question 19

What are sx of toxic shock

Answer 19

Fever, rash, sore throat, mods, staph aureus exotoxin

Question 20

what is pelvic cellulitis?

Answer 20

common post hysterectomy, vaginal vault, erythema, induration, tenderness.

Question 21

A 20 year old woman presents to the ER with right lower quadrant pain. After establishing that the patient is stable, what is the most important test to order?

a) Urinalysis
b) Amylase
c) Liver function tests
d) Arterial blood gases
e) Serum β-hCG

Answer 21

serum beta hcg

Question 22

A previously healthy 42 yo woman comes to clinic b/c of a 6-mo hx of increasingly heavy menstrual periods and a 2-mo hx of prolonged flow. Exam reveals a slightly enlarged, smooth, freely mobile uterus. Abdominal US shows a 4-cm leiomyoma uteri. Which of the following is the most likely type of leiomyoma?

a) Parasitic
b) Subserosal
c) Submucosal
d) Pedunculated
e) Intramural

Answer 22

Submucosal

Question 23

A 23y.o. female presents to the ED with RLQ abdominal pain. Pain began suddenly, is sharp, has worsened over the past 4 hours and is associated with nausea and vomiting. She denies any fever, diarrhea, urinary symptoms, vaginal discharge or bleeding. LMP was 3 weeks ago and she is in an OCP. HR 115bpm, other vitals are stable.

Ddx

Answer 23

a) Ovarian cyst torsion
b) Ruptured or hemorrhagic ovarian cyst
c) Ectopic pregnancy
d) PID
e) Appendicitis
f) UTI
g) Renal colic
h) Degenerating leiomyoma

Question 24

A 21 year old woman has had persistent superficial
dyspareunia for the past year. She is otherwise
asymptomatic. Vaginal cultures have been negative
on 3 occasions. On examination, the skin located
just exterior to the hymen is slightly reddened and
painful to the touch. Which one of the following is
the most likely diagnosis?

a) Persistent herpes infection
b) Lichen sclerosus
c) Human papillomavirus infection
d) Vestibulitis
e) Allergic vulvitis

Answer 24

d)Vestibulitis

Question 25

What are the sx of interstitial cystitis

Answer 25

UTI sx (pain, pressure, discomfort) Can last 6wk